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UPMC Health Plan in Pittsburgh, PA seeks multiple Actuarial Leads to apply knowledge of mathematics, probability and statistics to identify issues, gather and analyze data on a wide variety of topics affecting the financial performance of the health plan; assist with reconciling Medicare Advantage Part C and Part D claims data to financials; analyze bid projections of Part B and Part D rebates; evaluate impact of proposed legislative and regulatory changes; develop assumptions, project costs and monitor emerging experience of Medicare Advantage Mandatory Supplemental Benefits including, but not limited to, transportation, vision, healthy foods, fitness and flex card; develop and analyze trend selections of various service categories including inpatient, outpatient, skilled nursing facility, durable medical equipment, Part B, ambulance, lab, physician and home health; assist with providing related party reporting regarding the Medicare Advantage Bid process; develop automation to assist with benefit pricing during the bid process and benefit changes during rebate reallocation leveraging VBA and knowledge with JSON files; perform competitive benchmarking on plan designs, profit margins and administrative expense using financials from statutory filings; respond to requests from CMS bid desk reviewers and other auditors; supervise junior staff, including actuarial analysts, in the completion their projects; assist with setting Premium Deficiency Reserves; supervises an actuarial analyst.

Job Responsibilities: (please list specific job responsibilities)

o Apply knowledge of mathematics, probability and statistics to identify issues, gather and analyze data on a wide variety of topics affecting the financial performance of the health plan;

o Assist with reconciling Medicare Advantage Part C and Part D claims data to financials;

o Analyze bid projections of Part B and Part D rebates;

o Evaluate impact of proposed legislative and regulatory changes;

o Develop assumptions, project costs and monitor emerging experience of Medicare Advantage Mandatory Supplemental Benefits including, but not limited to, transportation, vision, healthy foods, fitness and flex card;

o Develop and analyze trend selections of various service categories including inpatient, outpatient, skilled nursing facility, durable medical equipment, Part B, ambulance, lab, physician and home health;

o Assist with providing related party reporting regarding the Medicare Advantage Bid process;

o Develop automation to assist with benefit pricing during the bid process and benefit changes during rebate reallocation leveraging VBA and knowledge with JSON files;

o Perform competitive benchmarking on plan designs, profit margins and administrative expense using financials from statutory filings;

o Respond to requests from CMS bid desk reviewers and other auditors;

o Supervise junior staff, including actuarial analysts, in the completion their projects;

o Assist with setting Premium Deficiency Reserves; and

o Supervises an actuarial analyst.

+ Master’s degree, or equivalent, in Actuarial Science, Mathematics, Statistics, Economics, or related field plus two (2) years of actuarial experience in health insurance/managed care, actuarial consulting to health actuaries, or related experience:

+ valuating and pricing Medicare (Part C and Part D);

+ building financial risk models from start to finish;

+ working with CMS BPTs (both Part C and Part D) and required reporting elements such as CMS MLR;

+ responding to and providing quantitative support for CMS for bid desk review, financial audit, and full bid audit;

+ developing risk scores, employing different risk models;

+ managing or training junior staff; utilizing tools and technologies including: SQL or SAS, Excel including VBA, macro development, data retrieval, and Power BI.

+ Must hold ASA or FSA certification by Society of Actuaries.

+ Telecommuting permissible.